Patient Understandings of Evidence and Therapeutic Effectiveness
Increasingly the second wave of EBHC has emphasised patient perspectives, evidence-based patient choice and evidence-based patient care. At least at the level of policy and representation, there has been a movement away from an emphasis on distanced cohort data with increased attention given to the applicability of data for individual patients and clinical contexts. Despite this, as Holmes and O’Byrne emphasise in Chapter 3, EBM and EBP have remained reliant on epidemiological data and reductive approaches to care regardless of linguistic and rhetorical shifts. It is for this reason that we place this chapter in Part III (‘Evidence on the Margins’) rather than in Part II (‘Evidence in the Clinic’). Whilst this is perhaps slightly provocative – there is some penetration of patient views on evidence into clinical environments – patient understandings of what constitutes effectiveness have been consistently marginalised. As shown in the data presented below, while patient perspectives are continuing to shape clinical work and clinical practices, they often vary significantly from those of biomedical clinicians and EBM/EBP advocates. A refocusing on what patients themselves understand as evidence becomes an inevitable conclusion.